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背景:胃黏膜相关淋巴组织(MALT)是幽门螺杆菌(M,pylori)感染的特殊征象,临床上较为常见,而胃MALT淋巴瘤则极为少见,两者在形态学上难以鉴别。目的:建立胃活检组织胃MALT淋巴瘤的阶梯式诊断流程,为H．pylori 根除治疗提供依据。方法:收集31例胃淋巴样增生(GLH)病例,行组织学、蛋白质、DNA和染色体水平的阶梯式检查。GLH组织学分级参照Isaacson标准,以免疫组化方法检测L26、UCHL-1、免疫球蛋白轻链κ、λ和Ki-67,半巢式聚合酶链反应(PCR)检测免疫球蛋白重链(IgH)基因重排,逆转录(RT)-PCR检测API2-MALT1融合。29例H．pylori感染者接受根除治疗,比较治疗前后的内镜和组织学表现。结果:23例GLH病例组织学分级为Ⅱ或Ⅲ级,仅2例为胃 MALT淋巴瘤(组织学Ⅴ级)。1例胃MALT淋巴瘤表达λ轻链限制,10例GLH(包括2例胃MALT淋巴瘤)检测到单克隆IgH基因重排．2例胃MALT淋巴瘤检测到API2-MALT1融合。随着GLH组织学分级的递增,Ki-67标记率和单克隆IgH基因重排检出率显著增高(P<0．05)。根除H．pylori后随访1．5-37个月,18例内镜和组织学完全缓解,4例部分缓解．7例无变化。结论:组织学结合Ki-67、IgH基因重排和API2-MALT1融合检测的阶梯式诊断流程有助于诊断早期胃MALT淋巴瘤．亦有助于药物治疗后的随访。
BACKGROUND: Gastric mucosa-associated lymphoid tissue (MALT) is a special sign of M. pylori infection, which is clinically common, and gastric MALT lymphoma is extremely rare. The two are morphologically indistinguishable. OBJECTIVE: To establish a stepwise diagnostic procedure for gastric MALT lymphoma in gastric biopsy, which is H. Pylori eradication treatment provides the basis. METHODS: Thirty-one cases of gastric lymphoid hyperplasia (GLH) were collected and examined stepwise in histology, protein, DNA, and chromosome levels. GLH histological grade was referenced to the Isaacson criteria, immunohistochemistry was used to detect L26, UCHL-1, immunoglobulin light chain kappa, lambda, and Ki-67, and semi-nested polymerase chain reaction (PCR) was used to detect immunoglobulin heavy chain ( IgH) gene rearrangements, reverse transcription (RT)-PCR detection of API2-MALT1 fusion. 29 cases H. Patients with pylori infection were treated with eradication therapy and endoscopic and histological findings before and after treatment were compared. Results: 23 cases of GLH histological grade II or III, only 2 cases of gastric MALT lymphoma (histological grade V). One case of gastric MALT lymphoma expressed lambda light chain restriction, and 10 cases of GLH (including 2 cases of gastric MALT lymphoma) detected monoclonal IgH gene rearrangement. API2-MALT1 fusion was detected in 2 cases of gastric MALT lymphoma. With the increase of histological grade of GLH, the detection rate of Ki-67 and the detection rate of monoclonal IgH gene rearrangement were significantly higher (P<0.05). Eradication of H. After pylori was followed up for 1.5-37 months, 18 cases of endoscopic and histological complete remission, 4 cases of partial remission. 7 cases did not change. Conclusion: The stepwise diagnostic procedure of histology combined with Ki-67, IgH gene rearrangement and API2-MALT1 fusion detection is helpful in the diagnosis of early gastric MALT lymphoma. It also facilitates follow-up after drug treatment.